Consciousness of evidence-based medicine in public health emergencies
Authors: Yao Zhang, Shuxing Wu, Xiangyu Ma
Journal: International Journal of Surgery (2023)

Dear Editor, In recent years, various public health emergencies have occurred one after another or persisted, posing a serious threat to global public health. There was the coronavirus disease-2019, which lasted nearly 3 years and caused more than 600 million infections and 6 million deaths worldwide1. There was also monkeypox, which swept through 41 countries in the European region in just 3 months, causing 21 098 cases and two deaths2,3. Additionally, there were the longest lasting polio outbreak, the resurgence of measles, dengue, and zika viruses, which turned people into mosquito bait, and other infectious diseases, injuries, climate change, natural disasters, local conflicts, etc. that seriously affect public health. Here we emphasize the consciousness of evidence-based medicine in public health emergencies. Field epidemiology is the theoretical and practical basis for emergency response at the scene of public health emergencies, using theories and methods from modern epidemiology and other disciplines to make timely scientific judgments and take effective control measures. September 7 has been set aside as the ‘World Field Epidemiology Day’ to highlight its mainstay role for evidence-based public health decisions and actions, and field epidemiologists are key to this endeavor4. However, although they receive systematic theoretical and practical training, many of the field epidemiologists only stay at the theoretical level and cannot translate theory into practical work ability, lacking evidence-based decision-making ability. At the early stages of public health emergencies, many questions still plagued professional staff. Such as, what exactly should be done in the face of an epidemic? How do you determine the epidemic intensity of the disease? When to start emergency response? How to determine the level of emergency response, etc. For clinicians, it is also extremely irresponsible for patients to tout drugs or interventions that have not been proven in any clinical trials or have only preliminary in vitro evidence. It is also a serious violation of the principles of evidence-based medicine for administrative decision-makers to rely on personal subjective judgments rather than professional advice. For the media, the random spread of information without scientific sources or even fabricated information to disturb the public will cause serious interference with the dissemination of scientific knowledge. This has raised the new term ‘infodemic, which means misinformation is spreading rapidly across the globe through social media platforms, posing serious problems for public health5. It might shape perceptions and influence public choices, even the policy design of the government and the social response of the public. ‘We’re not just fighting an epidemic; we’re fighting an infodemic, said WHO Director-General Tedros Adhanom Ghebreyesus. These problems have raised new concerns about the promotion and dissemination of evidence-based medicine in public health emergencies. The content and form of training have posed new challenges. Training is not only for professionals, but also for the media, the public, and administrative decision-makers. Evidence-based medicine is an important advancement over previous empirical medicine. It drives the practice of medicine from subjective to objective, from physician-led to an organic integration of doctors and patients. Likewise, it will today bear the burden of stopping misinformation and promoting the dissemination of scientific knowledge in public health emergencies. For medical professionals, evidence-based medicine encourages them to assimilate and implement new, valid, and relevant scientific knowledge as part of their daily clinical work. Of them, we should pay more attention to the cultivation of the evidence-based concept among medical undergraduates, who are the reserve strength of medical professionals. An early introduction to the fundamentals of evidence-based medicine is essential to improve critical thinking and promote a deeper understanding of how medical knowledge is built up over years of translational research. For administrative decision-makers, the ability to make evidence-based decisions is important. An arbitrary decision can often lead to serious public harm and a waste of social resources. For media practitioners, we can provide training on the basic concepts of evidence-based medicine through online resources to help them establish initial medical information verification and discrimination skills to avoid the dissemination of misinformation. Of course, these online courses are also suitable for our public to acquire the initial ability to verify medical information. At the same time, we should strengthen information monitoring and establish an evidence-based information base to provide timely and authoritative information and correct misinformation. Evidence-based medicine is not perfect and faces many challenges. For example, the pandemic of coronavirus disease-2019 resulted in many clinical trials with too small sample sizes and low-quality systematic reviews6. These are not actually errors in the discipline of evidence-based medicine and can be avoided through rigorous study design and quality evaluation. Emergencies are not a reason to lower publication standards and, in turn, criticize the faults of evidence-based medicine. Conversely, it can provide us with more scientific and reliable information conducive to scientific health policy decision making and promote the development of academic medicine to reach a newer and higher level, which is better for human services in public health emergencies. Ethical approval Not applicable. Sources of funding This research was funded by the education reform fund of the Army Medical University (2021A03) and “Jingke” project (JK030). Author’s contribution MX and WS: designed the study. MX, ZY and WS: made the first draft. MX, ZY and WS: reviewed the final draft and edited final. All authors have critically reviewed and approved the final draft and are responsible for the content of the manuscript. Conflicts of interest disclosure All authors report no conflicts of interest relevant to this article. Research registration Unique Identifying number (UIN) None. Guarantor All authors. Provenance and peer review Not commissioned, internally peer-reviewed. Data statement The data in this correspondence article is not sensitive in nature and is accessible in the public domain. The data is therefore available and not of a confidential nature.